I commented on a blog the other day, Headache and Migraine News Blog. I thought I would post it since patients that ask for pain meds that begin with the letter “D” always raise ER staffs’ attentions.
” I have virtually stopped giving Demerol all together for any condition. There are several reasons. First, it is very short acting. Second, it has toxic metabolites. Third, it is about as addictive as it gets – sufferers of moderate to severe pain often become dependent on Demerol. Fourth, the people that get it often go into a delirious state for an hour or two afterwards. Fifth, I have accidentally OD’d several people on it – I gave the “usual” dose of 50 or 75mg and in each case they almost stopped breathing I had to reverse them with Narcan. Sixth, there are better drugs out there – injectable Imitrex, Reglan, Decadron, Depakote, and even Morphine (which is safer, easier to titrate, and less often abused). Finally, it is a drug of choice for drug seekers who exaggerate or fake symptoms. You get the ole’ “The doctor gave me something that begins with D – yeah, that is what I want”. Some hospitals have completely removed Demerol from the formulary and they have noticed a huge drop in visits by the repeat offenders.”
Another drug that starts with “D”, Dilaudid (hydromorphone) is also popular – but I find it is much safer and produces less “high”. Thus, I give it if Morphine has failed.